Project Summary/Abstract: The prevalence of obesity among adolescents (ages 12-19) continues to be a serious public health problem as the most recent national survey (NHANES: 2015-2016) reported 20.5% of adolescents have a BMI > 95th percentile. Especially concerning is the steady increase of severe obesity (? 120% of the 95th percentile for BMI) within this age group. Also the concurrent rise in obesity-related health complications, such as insulin resistance, dyslipidemia, and fatty liver disease, underscores this major health burden from severe obesity. The recommended treatment for adolescents with obesity is a pediatric weight management (PWM) program offered in a tertiary-care setting that combines dietary, physical activity and behavioral strategies, using a patient- centered model with frequent contact. However this approach often has poor adherence to treatment and high attrition rates. Providing at least 26 hours of contact over a 6-month treatment period was found to be most effective, but a recent survey of 29 PWM programs in POWER (Pediatric Obesity Weight Evaluation Registry) found most sites offer low-intensity interventions (<26 hours) due to limited resources and patient circumstances. To improve the effectiveness of PWM programs, this proposed study has identified a ?bundle of program enhancements? (BPE) informed by a literature review, preliminary POWER outcomes, and evaluation of program characteristics of POWER?s ?top-performing? sites. The BPE components are: 1) Increasing provider contact hours in existing PWM programs to reach 26 hours during a 6-month treatment period by using remote interactive technologies to supplement standard-of-care clinic visits; 2) Identification of mental health problems during an individual program orientation prior to starting a PWM program, in order to initiate needed treatment as part of a PWM program; and 3) Evaluation of ?readiness to change? and ?barriers to making lifestyle changes? with motivational interviewing during the orientation session, allowing for interventions tailored to the patient?s needs. The proposed study is a pilot pragmatic trial designed to test the feasibility, acceptance, and preliminary effectiveness of the BPE (Intervention group: N=40) vs. standard-of-care (Control group: N=20) for adolescents with severe obesity in PWM programs at two POWER sites. The primary aims are: 1) Test whether existing PWM programs can successfully implement the BPE for 80% of participants randomly assigned to the Intervention group and 2) Test whether 70% of participants in the Intervention group will complete 26 contact hours during 6 months of treatment. The secondary aims test whether the Intervention group has greater rates of participation and retention, plus better health outcomes compared to the Control group. If the results of this pilot study are promising, then a fully-powered multi-site clinical trial can be designed to evaluate the BPE?s efficacy in existing PWM programs. By developing more successful evidence-based interventions for PWM programs, this research can help reverse the adolescent obesity epidemic and prevent the onset or worsening of comorbidities.